Peroneal electrical transcutaneous neuromodulation (peroneal eTNM®) for the treatment of OAB-review on principles, mode of action and clinical outcomes.

PURPOSE: Overactive bladder (OAB) is a prevalent condition with substantial impact on quality of life and healthcare resources. Neuromodulation has become an established therapeutic option, with ongoing efforts to develop less invasive and more effective modalities. Peroneal electrical transcutaneous neuromodulation (peroneal eTNM®) is a novel, non-invasive technique designed to provide selective stimulation of the peroneal nerve. This narrative review summarises its principles, mechanisms of action and available clinical evidence.

METHODS

A comprehensive PubMed search was conducted in March 2026 using keywords related to OAB and neuromodulation, restricted to English full-text articles published between 2015 and 2026. A total of 624 records were screened by title, and 11 relevant studies were included. Additional articles were identified through reference list screening.

RESULTS

Peroneal eTNM® delivers intermittent, bilateral, selective stimulation of the peroneal nerve using a closed-loop system with biofeedback. Functional neuroimaging studies demonstrate modulation of supraspinal structures involved in bladder control, supporting a central mechanism of action. Clinical studies consistently show significant improvements in urgency, urgency urinary incontinence, frequency and nocturia. Responder rates ranged from 72% to 87% across prospective and randomized trials, with efficacy comparable to established antimuscarinic therapy. Long-term follow-up indicates sustained benefit in a substantial proportion of patients. The treatment is associated with excellent safety, minimal discomfort and high adherence rates.

CONCLUSION

Peroneal eTNM® represents a promising, non-invasive neuromodulation modality with clinically meaningful efficacy, favourable tolerability and strong mechanistic rationale. Further large-scale comparative studies are warranted to define its role within OAB treatment algorithms.